Substance Use Disorders

Question 1

“When a dose of a medication gives less effect over time” is the definition of ___

Answer 1

Tolerance

Question 2

“When decreased doses of a medication leads to withdrawal symptoms” is the definition of ___

Answer 2

Physical dependence

Question 3

“Drug use exceeding recommended therapy which leads to increased adverse effects” is the definition of ___

Answer 3

Drug abuse

Question 4

What are the “Five Cs” of addiction?

Answer 4

Compulsive
Chronic 
decreased Control
Continued use
Cravings

Question 5

What scheduled control is cocaine?

Answer 5

Schedule II

Question 6

What is the MoA of cocaine?

Answer 6

Prevents reabsorption of 5HT, NE, EPI, and DA

Question 7

How is cocaine withdrawal treated?

Answer 7

Supportive care, fluids, multivitamins+B+C

Question 8

True or False? There are no FDA-approved medications to treat cocaine use disorder

Answer 8

True. Psychosocial therapy is first-line

Question 9

___ converts acetaldehyde to acetic acid

Answer 9

Aldehyde dehydrogenase

Question 10

What is the MoA of disulfuram?

Answer 10

Disulfuram inhibits aldehyde dehydrogenase, which causes a buildup of acetaldehyde and makes the patient feel sick if they ingest alcohol

Question 11

Disulfuram is contraindicated with ___ and ___

Answer 11

Ethanol

Metronidazole

Question 12

What is the BBW of disufuram?

Answer 12

Do not administer to an alcohol intoxicated patient (< 12 hours since last drink) or without their full knowledge

Question 13

What is the MoA of acamprosate?

Answer 13

Acamprosate decreases cravings for alcohol

Question 14

Acamprosate is contraindicated in ___

Answer 14

CrCl < 30

Question 15

What is the dose for acamprosate?

Answer 15

666mg TID

If CrCl is between 30-50, 333mg TID

Question 16

What is the MoA of naltrexone?

Answer 16

Naltrexone decreases cravings for alcohol

Question 17

Naltrexone is contraindicated with ___

Answer 17

Opioid use

Question 18

What is the dose for naltrexone?

Answer 18

PO: 50-100mg/day
IM: 380mg every 28 days

Question 19

What is the mechanism of topiramate?

Answer 19

Increases GABA and decreases cravings for alcohol

Question 20

True or False? Topiramate is FDA approved for the treatment of alcohol use disorder

Answer 20

False. It decreases cravings, but is not FDA approved for treatment of alcohol use disorder

Question 21

How do you treat alcohol withdrawal?

Answer 21

To prevent wernicke-korsakoff syndrome, give folate, thiamine (B1), multivitamin, crystalloid fluids (D5W+KCl), benzodiazepines

Question 22

What are the three opioid receptors?

Answer 22

Mu, Kappa, Delta

Question 23

What medication is an opioid antagonist used for reversing opioid overdose?

Answer 23

Naloxone

Question 24

What is the acronym for the opioid withdrawal scale?

Answer 24

COWS

Question 25

What medications are used for maintenance of opioid use disorder?

Answer 25

Naltrexone (mu opioid antagonist) Methadone: CII (full mu opioid agonist) Buprenorphine: CIII (partial mu opioid agonist)

Question 26

What is the MoA of naloxone

Answer 26

Mu antagonist

Question 27

JB is going to be induced on Suboxone. What would you tell him about how Suboxone works? It is a: a. Mu agonist b. Mu antagonist c. Partial mu agonist

Answer 27

B & C. Mu antagonist and partial mu agonist

Question 28

SB is a 33 yo F with a history of alcohol use disorder. SB states she drinks 1 liter of vodka daily. She reports alcohol is her drug of choice, but also states she uses $50 worth of heroin every few days. She presents to inpatient substance use program for treatment of alcohol and heroin. What medication would be preferred for SB? a. Methadone b. Naltrexone c. Acamprosate d. Topiramate

Answer 28

B. Naltrexone is FDA indicated for both alcohol use disorder and opioid use disorder

Question 29

What are examples of depressants?

Answer 29

``` Alcohol Benzodiazepines Barbiturates Sedative-hypnotics Opioids Cannabis ```

Question 30

What are examples of stimulants?

Answer 30

Caffeine Cocaine Amphetamine/Methamphetamine MDMA/Ecstasy

Question 31

What are examples of hallucinogens?

Answer 31

``` Lysergic acid diethylamide (LSD) Psilocybin (mushrooms) DMT Mescaline (peyote) Phencyclidine (PCP) ```

Question 32

What are the effects of stimulant intoxication?

Answer 32

``` Tachycardia or bradycardia Pupillary dilation Elevated or lowered blood pressure Perspiration or chills Nausea or vomiting Evidence of weight loss Psychomotor agitation or retardation Muscular weakness Respiratory depression, chest pain, or cardiac arrhythmias Confusion, seizures, dyskinesias, dystonias, or coma ```

Question 33

What are symptoms of alcohol withdrawal?

Answer 33

``` Tachycardia Hypertension Anxiety Dysphoria N/V Tremors Anxiety Confusion, agitation, fever, and/or seizures if prolonged ```

Question 34

What are symptoms of opioid withdrawal?

Answer 34

``` NV Stomach cramps Diarrhea Goosebumps Depression Drug cravings ```

Question 35

LB is a 27 yo M with PMH of migraines. LB presents to the ED sweating, nauseous, and very agitated. BP:172/90; HR: 86; T: 98.9 Which of the following substances may be the offending agent? a. Heroin b. Alcohol c. Cocaine d. Oxycodone

Answer 35

c. Cocaine